PROSTATE ENLARGEMENT

PROSTATE ENLARGEMENT: New advancements in treatment PROSTATE ENLARGEMENT: A COMMON PROBLEM 50% of all men have an enlarged prostate by age 60 80% of men have an enlarged prostate by age 80 SO, WHAT IS THE PROSTATE, ANYWAY? THE PROSTATE Small, walnut sized gland located below the bladder Surrounds the urethra Involved in reproductive function Bladder Urethra Ureter Ureter Opening Prostate Prostati Urethra c PROSTATE ENLARGEMENT Also called benign prostatic hyperplasia (BPH) Benign growth of prostate gland Not cancer, nor does it lead to cancer THE NORMAL PROSTATE Bladder Small Urethra unobstructed Free flow of urine THE ENLARGED PROSTATE Gradually increases in size “Squeezes” urethra Results in: – Difficulty in urination – Incomplete bladder emptying – Possible infection and kidney damage Bladder CAN IT BE PREVENTED? Prostate enlargement is a natural part of aging SYMPTOMS OF PROSTATE ENLARGEMENT Weak urine stream Nighttime urination Frequent or urgent urination Starting and stopping of urination Hesitancy of stream Sensation of incomplete bladder emptying Painful or burning urination SYMPTOMS OF AN ENLARGED PROSTATE May vary with severity of condition Each patient experiences symptoms differently Symptoms may worsen without treatment TESTS YOUR DOCTOR MAY PERFORM Digital rectal exam (DRE) Ultrasound Urine flow study Cystoscopy THE GOOD NEWS IS PROSTATE ENLARGEMENT IS TREATABLE THREE TREATMENT CATEGORIES Drug therapy Surgery Minimally invasive treatments DRUG THERAPY OPTIONS Proscar® (finasteride) Hytrin® (terazosin) Cardura® (doxazosin) Flomax® (tamsulosin) DRUG THERAPY Advantages – No surgery – Effective for mild to moderate symptoms Disadvantages – Lifelong commitment to therapy – Effectiveness may decrease over time SURGICAL OPTIONS Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP) Open prostatectomy TRANSURETHRAL RESECTION OF PROSTATE (TURP) Most common surgical option for enlarged prostate Transurethral = through the urethra No incision through the abdomen TRANSURETHRAL RESECTION OF PROSTATE (TURP) Excess tissue removed one piece at a time Tissue “flushed” out of body Potential side effects: – impotence – retrograde ejaculation – incontinence TRANSURETHRAL INCISION OF PROSTATE (TUIP) Transurethral procedure Small cuts made in bladder neck and prostate to widen urethra No prostate tissue removed Less risk of side effects when compared to TURP Not suitable for large glands OPEN PROSTATECTOMY Used for very enlarged prostates Major surgery requiring abdominal incision Enlarged portion of prostate removed by surgeon Greater risk of surgical complications Longer recovery time MINIMALLY INVASIVE TREATMENTS Major advances made in treatment Advanced technology Advantages: – Designed to enhanced patient comfort – Reduced risk of complications – Potentially reduced side effects MINIMALLY INVASIVE TREATMENTS Transurethral microwave thermotherapy (TUMT) Transurethral needle ablation (TUNA) Interstitial laser coagulation (ILC) TRANSURETHRAL MICROWAVE THERMOTHERAPY (TUMT) Uses microwaves to heat and destroy excess prostate tissue Not effective for certain cases High power level may cause discomfort Treatment typically takes 1-2 hrs Many patients require retreatment1 1. Indigo Medical, Inc. BPH Advisory Panel Meeting. Physicians’ Dialogue: Expert Opinion About Minimally Invasive Therapy for BPH. 1999: 20. TRANSURETHRAL NEEDLE ABLATION (TUNA) Uses radiowaves to destroy enlarged tissue Not effective for all cases Low risk of side effects Studies have shown that more than 27% of patients have elected TURP eventually1 1. Indigo Medical, Inc. BPH Advisory Panel Meeting. Physicians’ Dialogue: Expert Opinion About Minimally Invasive Therapy for BPH. 1999: 20. INTERSTITIAL LASER COAGULATION (ILC) One of the newest, most widely used minimally invasive therapies1 Transurethral procedure Heat from laser coagulates excess tissue Excess tissue absorbed by body Gradual decrease of symptoms 1. Synergy Healthcare Market Share Information. INTERSTITIAL LASER COAGULATION (ILC) Precision of laser allows precise treatment of tissue Designed to minimize risk of damage to urethra and tissue around the prostate INTERSTITIAL LASER COAGULATION (ILC) Can be performed in outpatient setting Local anesthesia possible1 Symptomatic relief comparable to TURP Reduced risk of incontinence and retrograde ejaculation 1. Greenberger M, Steiner MS. The University of Tennessee experience with the Indigo 830e laser device for the minimally invasive treatment of benign prostatic hyperplasia: interim analysis. World Journal of Urology. 1998;16(6):386-91. THE ILC PROCEDURE Anesthetic administered Cystoscope inserted through urethra Special fiber optic inserted into prostate through scope Laser energy delivered to precise area Process repeated until sufficient tissue coagulated THE ILC PROCEDURE Takes usually less than 1 hour Short-term catheterization required post-op Initial symptom improvement typically within 3 to 4 weeks Symptoms typically continue to improve over 8 to 12 weeks CHOOSING THE BEST OPTION More options mean more difficult decisions Learn the facts Talk to your doctor REMEMBER…EARLY DIAGNOSIS IS THE KEY TO SUCCESSFUL TREATMENT EARLY DIAGNOSIS Annual prostate exams after age 50 See your doctor immediately if you have any symptoms QUESTIONS?